Age-related treatment patterns in sickle cell disease patients and the associated sickle cell complications and healthcare costs
Age-related treatment patterns in sickle cell disease patients and the associated sickle cell complications and healthcare costs
复制标题
DOI：
10.1002/pbc.24459
复制
发表时间：
2013-05-01
影响因子：
3.2
通讯作者：
Duh, Mei Sheng
中科院分区：
文献类型：
--
作者：
Blinder, Morey A.;Vekeman, Francis;Duh, Mei Sheng
本研究探讨了儿童、过渡期（18岁）和成人SCD患者的输血模式、SCD并发症、铁螯合疗法（ICT）的利用、医疗资源的使用和费用。使用了来自佛罗里达（1998 - 2009）、新泽西（1996 - 2009）、密苏里州（1997 - 2010）、堪萨斯（2001 - 2009）和爱荷华州（1998 - 2010）医疗补助的手术数据。纳入了2例SCD诊断和1例输血事件的患者。计算输血事件、SCD并发症的发生率和接受ICT的合格患者比例。ICT资格定义为一生中接受10次输血。SCD并发症包括疼痛、肺部事件、感染事件、肾脏、心血管、卒中、腿部溃疡和缺血性坏死。回归分析用于评估输血的风险因素，并确定成本的主要驱动因素。结果共纳入患者3,208例。输血率从1岁开始增加，16岁达到高峰，然后下降，直到26岁，此后保持稳定。相比之下，SCD并发症的诊断频率在16岁后显着增加。过渡期后患者（18岁）与输血次数减少显著相关（比值比：0.80，P=0.002）。在符合ICT条件的患者中，ICT组和非ICT组之间的总成本没有统计学显著差异（调整后的成本差异为136美元，P=0.114）。结论：与儿科患者相比，过渡到成人护理的患者接受较少的输血和羟基脲，在符合螯合治疗条件时较少ICT，医疗费用较高，并且患有更频繁的SCD相关并发症。这些发现突出了治疗模式的变化，相应的过渡到成人护理。儿科血液癌症2013; 60：828835。(c)2013 Wiley Periodicals，Inc.
Background This study explored the blood transfusion patterns, SCD complications, utilization of iron chelation therapies (ICT), healthcare resource use, and costs in pediatric, transitioning (18 years old) and adult patients with SCD. Procedure Data from Florida (19982009), New Jersey (19962009), Missouri (19972010), Kansas (20012009), and Iowa (19982010) state Medicaid were used. Patients with 2 SCD diagnoses and 1 transfusion event were included. Rates of transfusion events, SCD complications, and proportion of eligible patients receiving ICT were calculated. ICT eligibility was defined as receiving 10 transfusions over lifetime. SCD complications included pain, pulmonary event, infection event, renal, cardiovascular, stroke, leg ulcers, and avascular necrosis. Regressions were used to assess risk factors for transfusion and identify the main drivers of costs. Results The sample included 3,208 patients. The transfusion rate increased from 1-year-old to a peak at 16 years old, then dropped until age 26 and remained stable thereafter. In contrast the frequency of diagnoses for SCD complications increased markedly after age 16. Post-transition patients (18 years old) were significantly associated with fewer transfusions (odds ratio: 0.80, P=0.002). Among eligible patients for ICT, there was no statistically significant difference in total cost between the ICT and no ICT groups (adjusted cost difference, $136, P=0.114). Conclusions Patients transitioning to adult care received less transfusions and hydroxyurea, less ICT when eligible for chelation therapy, had higher healthcare costs and suffered from more frequent SCD related complications than pediatric patients. These findings highlight the changes in treatment patterns corresponding to transition to adult care. Pediatr Blood Cancer 2013; 60: 828835. (c) 2013 Wiley Periodicals, Inc.